Worn

I am wearing thin.

It has continued to be hectic at work with much of the same old routine. We've had a roster change meaning that we work slightly less, and get paid less, so that we have enough money to pay for an extra registrar which on the whole is a Good Thing.

So I've not been worn down because of the usual scut, but by a rather malign reversal of the dictum that doctors need to empathize with patients and their families and "walk in their shoes."

The last couple of weeks have been characterized by demanding families belittling, insulting and otherwise degrading medical and nursing staff.

Amongst other things, events came to a head a few days ago when I had to try to obtain a Not For Resuscitation (NFR) order for one of our patients. A NFR order is a decision by medical staff to not use aggressive measures like CPR or ventilation machines on a patient in the event that their heart or lungs stop, with the reasoning that the potential benefits are miniscule and that the quality of life after such a resuscitation is extremely poor. We make this decision in consultation with the patient or the family of the patient.

It is NOT a decision by the staff that we do nothing. Non-invasive and conservative measures are all still applied as appropriate.

I had been warned by my registrar that this particular family would be difficult to convince of the validity of our position. I sat down on the phone with them, and over the course of an hour I tried to explain that our position on NFR for their relative came out of a desire to preserve quality of life and to avoid doing harm. I did my best to assure them that we were still committed to using all other measures at hand. I asked them to think about it and discuss it with me when they came in later.

When they came, I asked them if they understood our position. The grand-daugther replied to me,

"Basically, you're saying my grand-father's an old piece of shit and no-one wants to do anything."

She went on to complain at me about the nursing staff, who had just been trying to salvage a intra-venous cannula but who had unfortunately caused the patient some discomfort.

"Basically, everyone's the same, so many sick people you just don't care and it's just a job to you people."

I stood there with the nurse unit manager and we were both speechless. There are just so many things you want to say when somebody accuses you of not giving two shits, but when you're the representative of a hospital you kind of have to sit there and take it in the face. Or, more realistically, in the ass.

"I think it's really unnecessary that you just inflict pain. It's unnecessary that you just use him as a pin cushion and stick needles into him."

My mouth ground shut. It boggled my mind how this person could reason that we would be failing in our duty if we didn't jump on her grand-father's chest (and in the process of CPR probably break all his ribs) or shove a large tube into his windpipe in the event of an arrest, and then turn around and complain about us trying to put needles into him that deliver vital fluids and antibiotics.

No, it's not unnecessary that we stick needles into him. What would be unnecessary would be me, sticking a needle into myself.

So that's what I did. The next day I got my medical students to cannulate one of my veins to remind myself of what it feels like. The med students looked at me like I was nuts, but they did it anyway, because for a med student, a chance to cannulate is a Good Day. For the record, they got it, first pass, too.

And yeah, sure, it hurts a bit. But life hurts. In the recent push to make doctors drop their God complex people forget that doctors were never god in the first place:

A hospital is not a magical place where the laws of physics and reality stop. A hospital is not a magical place where the laws of economics and taxes stop.

When I say that I'm sorry that I couldn't get there sooner or that a nurse couldn't get there sooner it's not because I left my Sonic Hedgehog Running Shoes in my other pants and I'm lying to your face.

When you ask me "Why aren't there more nurses and doctors?" you forget two vital things. For one (If I may paraphrase Dr Bones McCoy from Star Trek) I'm a doctor, not a politician, nor a font of unending financial resources or the silver bullet to a flagging health system. If you've got problems with our health system, use your DEMOCRATIC RIGHT and tell your member of parliament. Don't tell me things I already know.

The other thing: The end of a 14 hour shift is ALWAYS the best time to tell a doctor that they don't care about their patients, it really is.